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Sturmberg JP, Gainsford L, Goodwin N, Pond D. Systemic failures in nursing home care-A scoping study. J Eval Clin Pract 2024; 30:484-496. [PMID: 38258966 DOI: 10.1111/jep.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/15/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024]
Abstract
Nursing homes (also referred to as residential aged care facilities, or long-term care facilities) cater for older people on a respite or long-term basis for those who are no longer able to live independently at home. Globally the sector struggles to meet societal expectations since it is torn between three competing agendas-meeting the needs of residents, meeting the demands of regulators, and meeting the financial imperatives of nursing home proprietors. Competing demands indicate that the system lacks a clear understanding of its purpose-without a clearly understood purpose any system will become dysfunctional overall and across all its levels of organisation. This scoping study aims to summarise and synthesise what is already known about the systemic function and failures in the nursing home system, and the impact this has on the wider health and aged care system. METHOD MEDLINE, EMBASE, PSYCHINFO, CINAHL and SCOPUS were searched using the terms: (nursing home care OR residential aged care OR nursing home) AND (organisational failure OR institutional failure OR systemic failure), limited to English language articles, including all years up to the end of February 2021. In addition, we used snowballing of article references and Google searches of the grey literature. System-focused articles were defined as those that explored how an issue at one system level impacted other system levels, or how an issue impacted at least two different agents at the same system level. RESULT Thirty-eight articles addressed systemic issues as defined in four different contexts: United States (14), Canada (2), Australia (11) and European countries (11). Only four studies reported whole-of-system findings, whereas the remaining 34 more narrowly addressed systemic features of specific nursing home issues. The thematic analysis identified 29 key systemic issues across five system layers which consistently appear across every country/health system context. The negative outcomes of these systemic failings include: high rates of regulatory reprimands for unacceptable or unsafe practices; dissatisfaction in care experiences on the part of residents, families, and care staff-including a fear of being sent to a nursing home; and the perception amongst staff that nursing homes are not preferred places to work. CONCLUSIONS The key issues affecting nursing home residents, and the care home sector more generally, are systemic in nature arising from two key issues: first, the lack of shared agreement on the care home system's purpose; and second, the lack of clear governance and accountability frameworks for system regulation and performance at a national level. Addressing these two key issues must be the starting point for any 'real' nursing home system redesign that can achieve a seamlessly integrated system that delivers the outcomes nursing home residents and their families expect. 'Systems thinking' is required to simultaneously improve care quality and outcomes for residents, strengthen regulation and accountability, and enable financial viability.
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Affiliation(s)
- Joachim P Sturmberg
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- International Society for Systems and Complexity Sciences for Health, Australia
| | - Len Gainsford
- Australian Government Tertiary Education Quality & Standards Agency Audit & Risk Committee & Chair, Transport Safety Victoria Audit Committee, Australia
- Centre for Enterprise Performance, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Nicholas Goodwin
- Central Coast Research Institute for Integrated Care, University of Newcastle and the Central Coast Local Health District, Newcastle, New South Wales, Australia
| | - Dimity Pond
- Wicking Dementia Research and Training Centre, University of Tasmania, Hobart, Tasmania, Australia
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Yang L, Zhou W, Gao Y, Wu T, Zhang H, Gan X. Development and validation of the missed intensive nursing care scale. BMC Nurs 2024; 23:165. [PMID: 38454469 PMCID: PMC10919009 DOI: 10.1186/s12912-024-01805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Missed nursing care is a pervasive issue in hospitals, nursing homes, and communities, posing a significant threat to patient safety and the quality of nursing care. It has adverse effects on patient satisfaction and the motivation of nursing staff. Understanding the causes and nature of these care omissions in clinical settings is essential for implementing effective interventions. This study aims to develop and validate a tool for assessing missed nursing care in adult intensive care units. METHODS Semi-structured interviews, expert consultations conducted via the Delphi method and item analysis were used to develop the initial scale. Our analysis involved data collected from 400 nurses and employed correlation coefficient analysis, critical ratio assessment, Cronbach's α coefficient evaluation, discrete trend analysis, and factor analysis, which were grounded in both classical test theory and item response theory, allowing us to scrutinize and refine the items in the scale. To validate the scale, we conveniently sampled 550 nurses and assessed structural validity, internal reliability, split-half reliability, and test-retest reliability to ensure the scale's robustness and accuracy. RESULTS The Missed Intensive Nursing Care Scale (MINCS) comprises three distinct components. Part A serves to collect general information about the participants. In Part B, the missed care elements are categorized into five domains, following the framework of Maslow's hierarchy of needs theory: physiology, safety, belongingness, esteem, and cognition. Part C is dedicated to detailing the reasons behind missed care, which encompass labor resources, material resources, communication factors, and managerial factors. Remarkably, the Cronbach's α coefficient for the MINCS stands at an impressive 0.951, with S-CVI values of 0.988 and 0.977 in Part B and C, respectively, underscoring the scale's exceptional reliability and validity. This demonstrates the scale's effectiveness in measuring missed nursing care while upholding rigorous standards of quality. CONCLUSIONS The MINCS emerges as a robust and dependable instrument for quantifying instances of missed care within the ICU. Its efficacy makes it a valuable resource for informing the development of strategies aimed at averting and mitigating the adverse effects associated with missed nursing care.
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Affiliation(s)
- Li Yang
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Wen Zhou
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Yan Gao
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Taiqin Wu
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Huan Zhang
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China
| | - Xiuni Gan
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Nanan District, Chongqing, China.
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Blatter C, Osińska M, Simon M, Zúñiga F. The relationship between nursing home staffing and resident safety outcomes: A systematic review of reviews. Int J Nurs Stud 2024; 150:104641. [PMID: 37992653 DOI: 10.1016/j.ijnurstu.2023.104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Resident safety is an important topic for nursing home practice with up to 33 % of residents subjected to an adverse event. In spite of a large evidence base examining the relationship between nursing home staffing and resident outcomes, the findings of several systematic reviews remain inconclusive and contradicting, possibly due to methodological shortcomings. OBJECTIVE The main aim of this review was to provide a comprehensive overview of the literature on nursing home staffing and its relationship with resident safety outcomes. DESIGN We undertook a systematic review of reviews. We searched Medline, CINAHL and Embase by the end of November 2022. Reviews were included if they assessed the relationship between nursing home staffing and resident safety outcomes using objective measures and data at resident level. Quality appraisal was conducted using the SIGN-checklist, but we did not exclude any reviews based on quality assessment. We used a narrative approach, tables and figures to summarize the findings. RESULTS We included 13 systematic reviews published between 2006 and 2022 building on primary evidence from 1977 to 2022. Twelve reviews investigated the relationship between nurse staffing and resident safety outcomes (187 unique primary studies), and one review focused on allied health professionals (28 primary studies). Five reviews originated as work to inform governmental recommendations on staffing. We found diverse approaches used to investigate the staffing-outcome relationship with regard to design, timeframe, operationalization, data-source and theoretical rationales guiding the studies. The most prominently reported resident safety outcomes were pressure ulcers and urinary tract infections. Commonly reported staffing measures included number and level of education of nursing home staff. Based on narrative summaries, staffing seems to have a favorable relationship with resident safety outcomes, but logic models explaining the mechanisms of this relationship were sparsely reported. CONCLUSIONS The existing literature shows methodological limitations that demand a change in research on the staffing-outcome relationship in the nursing home setting. Our work highlights the need for carefully designed primary studies that address the pertinent shortcomings by design, timeframe, operationalization, data-source and theoretical rationales. These future studies will allow to carefully examine the causal relationship between selected staffing measures and resident safety outcomes in further detail and serve as legitimate evidence bases to inform action plans for clinical practice and to evaluate staffing policies.
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Affiliation(s)
- Catherine Blatter
- Institute of Nursing Science, University of Basel, Switzerland. https://twitter.com/cathblatter
| | | | - Michael Simon
- Institute of Nursing Science, University of Basel, Switzerland. https://twitter.com/msimoninfo
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Tate K, Palfreyman S, Reid RC, McLane P, Cummings GG. Incidence of Pressure Injury Among Older Adults Transitioning from Long-term Care to the ED. Adv Skin Wound Care 2023; 36:651-657. [PMID: 37983578 DOI: 10.1097/asw.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To identify sociodemographic, health condition, and organizational/process factors associated with pressure injury (PI) incidence during older adults' emergency transitions from long-term care (LTC) to the ED. METHODS Emergency transitions were tracked for older adults within included LTC facilities to participating EDs in two urban centers located in provinces in Canada. Binary logistic regression was used to examine the influence of sociodemographic, service use, and client health and function factors on the incidence of PIs during transitions from LTC facilities to EDs. RESULTS Having a mobility issue (odds ratio [OR], 4.318; 95% CI, 1.344-13.870), transitioning from a publicly owned versus a nonprofit volunteer LTC facility (OR, 4.886; 95% CI, 1.157-20.634), and time from ED arrival to return to LTC being 7 to 9 days (OR, 41.327; 95% CI, 2.691-634.574) or greater than 9 days (OR, 77.639; 95% CI, 5.727-1,052.485) significantly increased the odds of experiencing a new skin injury upon return to LTC. A higher number of reported reasons for emergency transition (up to 4) significantly decreased the odds of a new PI upon return to LTC (OR, 0.315; 95% CI, 0.113-0.880). CONCLUSIONS The study findings can be used to identify LTC residents at increased risk for developing new skin injuries during an emergency transition, namely, those with mobility impairment, those requiring inpatient care for 6 or more days, and those transitioning from publicly owned LTC facilities. Evaluating the uptake and effectiveness of single-pronged and multipronged interventions such as visual cues for patient turning through online monitoring, consistent risk assessments, and improved nutrition in all care settings are vital next steps in preventing skin injuries in this population.
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Affiliation(s)
- Kaitlyn Tate
- At the University of Alberta, Edmonton, Alberta, Canada, Kaitlyn Tate, PhD, RN, is Assistant Professor, Faculty of Nursing, College of Health Sciences, and Simon Palfreyman, PhD, RN, is Associate Teaching Professor. R. Colin Reid, PhD is Assistant Professor, School of Health and Exercise Sciences, University of British Columbia-Okanagan campus, Kelowna. Patrick McLane, PhD, is Assistant Scientific Director, Emergency Strategic Clinical Network, Alberta Health Services, Edmonton. Also at University of Alberta, Greta G. Cummings, PhD, RN, FAAN, FCAHS, FCAN, is Dean and Professor, Faculty of Nursing, College of Health Sciences. Acknowledgment: The authors acknowledge the OPTIC (Older Persons' Transitions in Care) study team for their contributions to the parent study from which this analysis and paper were generated. This study was funded by the Canadian Institutes of Health Research (CIHR grant CIHR PHE 101863); the Michael Smith Foundation for Health Research; Alberta Foundation of Medical Research; Alberta Health Services; Interior Health Authority, Kelowna, British Columbia; the University of Alberta Hospital Foundation; and the British Columbia Network for Aging Research. The authors have disclosed no other financial relationships related to this article. Submitted September 7, 2022; accepted in revised form January 9, 2023
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Hartviksen TA, Aspfors J, Uhrenfeldt L. Suffering while resigning to an unacceptable violation of dignity. Nurs Ethics 2023:9697330231209295. [PMID: 37867258 DOI: 10.1177/09697330231209295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND The interaction of health personnel with relatives is linked to the quality of care results in nursing homes. However, there is limited knowledge of how relatives perceive being an integral part of the nursing home context. This secondary analysis has its starting point in an ethical concern about relatives' experiences in a previous study. AIM To critically discuss relatives' experiences of suffering when their next of kin live in a nursing home in a rural arctic context. RESEARCH DESIGN, PARTICIPANTS AND CONTEXT The critical hermeneutic stance is informed by Habermas. The secondary analysis is conducted on original data from five semi-structured focus groups with 18 relatives of residents of two nursing homes in a rural part of Norway. The theoretical framework concerning dignity, well-being, and suffering, as developed by Galvin and Todres, contrasts the analysis. ETHICAL CONSIDERATIONS The study followed the principles of the Helsinki Declaration. It was approved by the Norwegian Center for Research Data (NSD) (reg. no. 993360). FINDINGS The main theme of this study is: suffering while resigning to an unacceptable violation of dignity. This theme is deepened by two subthemes: (a) suffering while adapting to a relationship of dependence and (b) suffering while accepting the unacceptable. CONCLUSIONS Relatives experience suffering as a cross-pressure in their struggle to interact responsibly with health personnel in nursing homes. This may have a negative outcome, where relatives end up adapting to being silent witnesses to missed care and a violation of dignity.
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Lund SB, Skolbekken JA, Mosqueda L, Malmedal WK. Legitimizing neglect - a qualitative study among nursing home staff in Norway. BMC Health Serv Res 2023; 23:212. [PMID: 36879261 PMCID: PMC9990246 DOI: 10.1186/s12913-023-09185-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Residents in nursing homes do not always get qualitatively good nursing care, and research shows that residents' basic care needs are sometimes neglected. Neglect in nursing homes is a challenging and complex issue, yet a preventable one. Nursing home staff are at the frontline of detecting and preventing neglect but may also be the ones causing it. It is essential to understand why and how neglect happens in order to recognize, expose, and prevent its occurrence. Our aim was to generate new knowledge on the processes leading to and allowing neglect to continue in Norwegian nursing homes, by studying how nursing home staff perceive and reflect on when nursing home residents are neglected in their daily practice. METHODS A qualitative exploratory design was used. The study was based on five focus group discussions (20 participants, total) and ten individual interviews with nursing home staff from 17 different nursing homes in Norway. The interviews were analysed according to Charmaz constructivist grounded theory. RESULTS In order to make neglect an acceptable practice, nursing home staff apply different strategies. These strategies were identified as when the staff legitimize neglect by neglecting neglect, when the staff are not recognizing their own behaviour as neglectful, as expressed in their actions and language, and normalizing missed care when resources are lacking and nursing staff are rationing care. CONCLUSIONS The gradual shift between judging actions as neglectful or not are made possible when nursing home staff legitimize neglect by not recognizing their practice as neglective, thus neglecting neglect or when they are normalizing missed care. Increased awareness and reflections on these processes may be a way of reducing the risk of and preventing neglect in nursing homes.
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Affiliation(s)
- Stine Borgen Lund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway.
| | - John-Arne Skolbekken
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway
| | - Laura Mosqueda
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Wenche K Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), PO Box 8905, Trondheim, 7491, Norway
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Andersson I, Bååth C, Nilsson J, Eklund AJ. Validation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care, a Swedish version. Nurs Open 2023. [PMID: 36855246 DOI: 10.1002/nop2.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/04/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
AIM The aim of the study was to translate, adapt and validate the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care for use in the Swedish community health care context. DESIGN A cross-sectional study. Data were collected from October 2019 to January 2020, and the questionnaire was sent to Registered Nurses, Enrolled Nurses and assistant nurses. METHODS The study was performed in four phases: (1) translation, (2) adaptation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care to the Swedish context, (3) content validity testing, and (4) evaluation of psychometric properties. The collected data resulted in 611 responses. Explorative factor analysis was performed to explore the interrelationship, and Cronbach's alpha was used to evaluate the internal consistency. RESULTS Explorative factor analysis presented six factors/subscales: (1) fundamental care, (2) timely needed-based care, (3) dignity and support, (4) ensuring respectful treatment, (5) social activities, and (6) documentation, planning and reporting. The Cronbach's alpha for the components showed values between 0.7 and 0.9. CONCLUSION The analyses indicate an instrument to be usable for Enrolled Nurses and nurse assistants in community health care. Additional tests, can contribute to refining the content of the items and further test reliability and validity of the instrument. NO PATIENT OR PUBLIC CONTRIBUTION As this is a study of translation and validation of the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care.
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Affiliation(s)
- Ingrid Andersson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Health, Welfare, and Organisation, Østfold University College, Halden, Norway
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
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Gill A, Al-Taweel O, He E, Al-Baghdadi Y, Jaradat M, Alalawi L, Rana J, Ahsan C. Impact of transfer from non-acute care centers on clinical outcomes in patients with congestive heart failure. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100251. [PMID: 38510190 PMCID: PMC10945999 DOI: 10.1016/j.ahjo.2023.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 03/22/2024]
Abstract
Study objective To compare the clinical outcomes in patients with congestive heart failure who are transferred to an acute care hospital from non-acute care centers with patients who are admitted as regular hospital admissions. Design This was a retrospective cohort study. Setting We utilized the National Inpatient Sample database from 2016 to 2018. Participants Our cohort consisted of hospitalized patients who were at least 18 years old with a primary diagnosis of congestive heart failure. Interventions These patients were either transferred from non-acute centers or presented as regular hospital admissions. Main outcome measurements We matched patients in a greedy nearest neighbor 1:1 model with caliper set at 0.2. Multivariable logistic regression, adjusted for age, sex, race and comorbidities, was used to compare mortality in our matched cohort. Results This study included 35,010 non-acute care transfers and 951,189 regularly admitted patients. Compared to patients who were not transferred, non-acute care transfers were older, predominantly female, White and less racially diverse. After matching, there were 6689 patients in each cohort. When adjusted for age, race, sex and comorbidities, non-acute care transfers with congestive heart failure had 2.20 times higher odds of suffering in-hospital mortality compared to regular, non-transferred admissions (aOR 2.20, 95 % CI: 1.85-2.61; p < 0.001). Conclusion Our findings illustrate that non-acute care transfers are a vulnerable population that require additional medical support in the acute care setting.
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Affiliation(s)
- Ahmad Gill
- Department of Internal Medicine, University of Nevada, Las Vegas, Las Vegas, NV, United States of America
| | - Omar Al-Taweel
- Department of Cardiology, University of Nevada, Las Vegas, Las Vegas, NV, United States of America
| | - Emily He
- Department of Internal Medicine, Loma Linda University, Loma Linda, CA, United States of America
| | - Yousif Al-Baghdadi
- Department of Internal Medicine, University of Nevada, Las Vegas, Las Vegas, NV, United States of America
| | - Mohammad Jaradat
- Department of Cardiology, Lenox Hill Hospital, New York City, NY, United States of America
| | - Luay Alalawi
- Department of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Jibran Rana
- Department of Cardiology, University of Nevada, Las Vegas, Las Vegas, NV, United States of America
| | - Chowdhury Ahsan
- Department of Cardiology, University of Nevada, Las Vegas, Las Vegas, NV, United States of America
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Ross A, Anderson JE, Selveindran S, MacBride T, Bowie P, Sherriff A, Young L, Fioratou E, Roddy E, Edwards H, Dewar B, Macpherson LM. A qualitative study of organisational resilience in care homes in Scotland. PLoS One 2022; 17:e0279376. [PMID: 36538564 PMCID: PMC9767361 DOI: 10.1371/journal.pone.0279376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Providing care for the dependent older person is complex and there have been persistent concerns about care quality as well as a growing recognition of the need for systems approaches to improvement. The I-SCOPE (Improving Systems of Care for the Older person) project employed Resilient Healthcare (RHC) theory and the CARE (Concepts for Applying Resilience) Model to study how care organisations adapt to complexity in everyday work, with the aim of exploring how to support resilient performance. The project was an in-depth qualitative study across multiple sites over 24 months. There were: 68 hours of non-participant observation, shadowing care staff at work and starting broad before narrowing to observe care domains of interest; n = 33 recorded one-to-one interviews (32 care staff and one senior inspector); three focus groups (n = 19; two with inspectors and one multi-disciplinary group); and five round table discussions on emergent results at a final project workshop (n = 31). All interviews and discussion groups were recorded and transcribed verbatim. Resident and family interviews (n = 8) were facilitated through use of emotional touchpoints. Analysis using QSR NVivo 12.0 focused on a) capturing everyday work in terms of the interplay between demand and capacity, adaptations and intended and unintended outcomes and b) a higher-level thematic description (care planning and use of information; coordination of everyday care activity; providing person-centred care) which gives an overview of resilient performance and how it might be enhanced. This gives important new insight for improvement. Conclusions are that resilience can be supported through more efficient use of information, supporting flexible adaptation, coordination across care domains, design of the physical environment, and family involvement based on realistic conversations about quality of life.
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Affiliation(s)
- Alastair Ross
- Glasgow Dental School, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Janet E. Anderson
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Monash, Australia
| | - Santhani Selveindran
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Tamsin MacBride
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Paul Bowie
- NHS Education for Scotland, Inverness, United Kingdom
| | - Andrea Sherriff
- Glasgow Dental School, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Linda Young
- NHS Education for Scotland, Inverness, United Kingdom
| | - Evie Fioratou
- Centre for Undergraduate Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Edel Roddy
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | | | - Belinda Dewar
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Lorna M. Macpherson
- Glasgow Dental School, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
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A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home. BMC Geriatr 2022; 22:849. [PMID: 36368919 PMCID: PMC9651899 DOI: 10.1186/s12877-022-03462-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs. Methods A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus. Results The participating NH’s care concept aims to improve residents’ functional abilities and wellbeing as well as staff members’ job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff. Conclusion The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.
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Campagna S, Conti A, Clari M, Basso I, Sciannameo V, Di Giulio P, Dimonte V. Factors Associated With Missed Nursing Care in Nursing Homes: A Multicentre Cross-sectional Study. Int J Health Policy Manag 2022; 11:1334-1341. [PMID: 33949814 PMCID: PMC9808324 DOI: 10.34172/ijhpm.2021.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite its association with patient safety, few studies on missed nursing care have been conducted in nursing homes. We aimed to describe individual and environmental factors in a sample of registered nurses (RNs) reporting missed nursing care in nursing homes, and to explore the association between these factors and missed nursing care. METHODS In the present, multicentre cross-sectional study, 217 RNs from 43 nursing homes in Northern Italy reported all episodes of missed nursing care (ie, any aspect of required care that was omitted or delayed) that occurred in the 20 most dependent residents (according to RNs' judgement; 860 residents in total) over 3 consecutive days. Multilevel multivariable logistic regression models were used to test possible explanatory factors of missed nursing care (individual, work-related, organisational, and work environment factors), which were entered in a step-wise manner. RESULTS Younger RNs (P=.026), freelance RNs (P=.046), RNs with a permanent contract (P=.035), and those working in publicly-owned nursing homes reported more episodes of missed nursing care (P<.012). Public ownership (odds ratio [OR]=9.88; 95% CI 2.22-44.03; P=.003), a higher proportion of residents with severe clinical conditions (OR=2.45; 95% CI 1.12-5.37; P=.025), a lower proportion of RNs (OR=2.24; 95% CI 1.10-4.54; P=.026), and perceived lack of time to care for residents (OR=2.33; 95% CI 1.04-5.26; P=.041) were statistically significantly associated with missed nursing care. CONCLUSION Factors associated with missed nursing care are similar in hospitals and nursing homes, and include heavy workload and perceived lack of time for care. Because missed nursing care in nursing homes represents tasks performed specifically by RNs, missed nursing care in this setting should be measured in terms of these tasks. An optimal skill mix is crucial to guarantee not only comfort and basic care for nursing home residents, but also good outcomes for residents with severe clinical conditions.
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Affiliation(s)
- Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Marco Clari
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Ines Basso
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Veronica Sciannameo
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padua, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Città della Salute e della Scienza di Torino University Hospital, Torino, Italy
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Vogelsmeier A, Popejoy L, Fritz E, Canada K, Ge B, Brandt L, Rantz M. Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity. BMC Health Serv Res 2022; 22:626. [PMID: 35538575 PMCID: PMC9087933 DOI: 10.1186/s12913-022-08036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood. Understanding these characteristics more fully will help identify appropriate intervention efforts needed to reduce repeat transfers. Methods This is a mixed-methods study using hospital transfer data, collected between 2017 and 2019, from long-stay nursing home residents residing in 16 Midwestern nursing homes who transferred four or more times within a 12-month timeframe. Data were obtained from an acute care transfer tool used in the Missouri Quality Initiative containing closed- and open-ended questions regarding hospital transfers. The Missouri Quality Initiative was a Centers for Medicare and Medicaid demonstration project focused on reducing avoidable hospital transfers for long stay nursing home residents. The purpose of the analysis presented here is to describe characteristics of residents from that project who experienced repeat transfers including resident age, race, and code status. Clinical, resident/family, and organizational factors that influenced transfers were also described. Results Findings indicate that younger residents (less than 65 years of age), those who were full-code status, and those who were Black were statistically more likely to experience repeat transfers. Clinical complexity, resident/family requests to transfer, and lack of nursing home resources to manage complex clinical conditions underlie repeat transfers, many of which were considered potentially avoidable. Conclusions Improved nursing home resources are needed to manage complex conditions in the NH and to help residents and families set realistic goals of care and plan for end of life thus reducing potentially avoidable transfers.
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Affiliation(s)
- Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Elizabeth Fritz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Kelli Canada
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Bin Ge
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Lea Brandt
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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13
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Prevalence, type, and reasons for missed nursing care in municipality health care in Sweden – A cross sectional study. BMC Nurs 2022; 21:95. [PMID: 35462537 PMCID: PMC9035238 DOI: 10.1186/s12912-022-00874-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background With an ageing population, there is an increasing need for care, both as home care and in nursing homes. However, some needed care is not carried out for different reasons, which can affect patient safety. The aim of the study was to describe prevalence, type, and reasons for missed nursing care in home care and nursing homes, from nurses’ perspective. Methods A cross sectional design with quantitative and qualitative approach. A Swedish version of Basel Extent of Rationing of Nursing Care for nursing homes and 15 study specific questions were answered by 624 registered nurses, enrolled nurses, or nurse assistants. Both descriptive and analytical, independent-samples t-test, analyses were used. Qualitative content analysis was used for the open-ended question. Results The care activity most often missed in home care was: ‘set up or update care plans’ (41.8%), and in nursing homes: ‘scheduled group activity’ (22.8%). Reasons for missed nursing care were lack of preparedness for unexpected situations, obstacles in a deficient work environment, unsatisfactory planning in the organisation, and/or shortcomings related to the individual. Conclusion Not all care activities needed are performed, due to reasons such as lack of time or organisational issues. Missed nursing care can lead to adverse events and affect patient safety. It is important to be aware of missed nursing care and the reasons for it, which gives a possibility to initiate quality improvement work to ensure patient safety.
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14
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Li C, Shi C. Adverse Events and Risk Management in Residential Aged Care Facilities: A Cross-Sectional Study in Hunan, China. Risk Manag Healthc Policy 2022; 15:529-542. [PMID: 35378829 PMCID: PMC8976485 DOI: 10.2147/rmhp.s351821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Adverse events threaten residents’ safety. Risk management is important to provide proper care and maintain quality in residential aged care facilities (RACFs). However, there is little data on adverse events, risk management, and risk early warning in RACFs in the Chinese mainland. This study aimed to fill this gap by investigating the prevalence of the aforementioned aspects and related factors in China. Participants and Methods Using a cross-sectional design, a field survey of 272 RACFs in Hunan Province was conducted from January 25 to June 1, 2020. Data were collected using four main tools on prevalence of nursing adverse events, risk management, risk early warning, and general information. Descriptive statistics were described by frequency (percentage) and median (interquartile range). Mann–Whitney U-test and Kruskal–Wallis H-test, and Spearman coefficient were used for statistical analysis. Results RACFs experienced an average of five (15) adverse events in 2019, with falls and pressure ulcers being the most common. The total average score of risk management in RACFs was 4.72 (0.98) out of 5, with the environment and personnel management dimensions scoring the highest with 4.75 (1) and the service management dimension scoring the lowest with 4.60 (1). Only 72.79% had trained their staff on ethical and legal knowledge and 84.56% had utilized pre-hospital first aid. Further, 30% to 40% were unprepared for contingency plans of suicide, electric shock, gas poisoning, and drowning. There were significant risk management differences among the following variables: facilities’ locations, accreditation with the Practice Certificate of Social Welfare Facilities, bed-size, nursing hours per resident day, requirement for nursing staff with certificates, and payment for nursing staff (p < 0.05). Conclusion RACFs are facing safety challenges with a high prevalence of nursing adverse events. These facilities need to improve risk early warning and management to ensure residents’ safety.
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Affiliation(s)
- Chunyan Li
- School of Nursing, Hunan University of Chinese Medicine, Changsha, People’s Republic of China
| | - Chunhong Shi
- School of Nursing, Xiangnan University, Chenzhou, People’s Republic of China
- Correspondence: Chunhong Shi, Tel +86 15907354840, Fax +86 735 2325007, Email
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15
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Shi C, Xu Y, Chen Y, Pu H, Yu Q, Wu X, Zhang Y. Perceptions and experiences of risk management by managers of residential aged care facilities: a qualitative study from Hunan Province, China. Int J Qual Stud Health Well-being 2021; 16:1978724. [PMID: 34558380 PMCID: PMC8475122 DOI: 10.1080/17482631.2021.1978724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background With adverse events and injuries recurring in residential aged care facilities (RACFs), older adults’ safety in residential age care settings has attracted extensive attention from governments, researchers, and healthcare providers. Risk management is of utmost importance in reducing risks and improving the quality of care for older adults in long-term care. Although previous studies have made great efforts to explore risk management methods and technologies in RACFs, little is known about how managers identify and respond to risks in practice. Purpose This qualitative study aimed to elucidate the perceptions and experiences of managers involved in risk management in RACFs in China. Participants and methods This study used a phenomenological research design. We conducted semi-structured interviews with 13 managers across 11 RACFs in Changsha City, Hunan Province, China. Data were analysed using Colaizzi’s seven steps and NVivo 12 plus software. Results “Facilitation of an error-free culture” emerged as a central theme of managers’ perceptions of risk management. Four sub-themes were revealed, namely “creating an age-friendly physical environment,” “paying close attention to frail older adults,” “improving the competence of nursing staff,” and “building effective management programs.” Conclusion Facilitation of an error-free culture was of prime importance in risk management. Managers’ experiences can help RACFs to better manage risks, as well as provide new perspectives and approaches for RACFs to improve the quality and outcomes of care. This study developed initiatives for improving resident safety in RACFs and may foster interest in the developing these initiatives.
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Affiliation(s)
- Chunhong Shi
- School of Nursing, XiangNan University, Chenzhou, China
| | - Yi Xu
- Nursing Department, Hunan Children's Hospital, Changsha, China
| | - Yang Chen
- Nursing Department, The People's Hospital of Bishan District of Chongqing City, Chongqing, China
| | - Haixu Pu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Qian Yu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaolian Wu
- School of Nursing, XiangNan University, Chenzhou, China
| | - Yinhua Zhang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
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16
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Andersson I, Bååth C, Nilsson J, Eklund AJ. A scoping review-Missed nursing care in community healthcare contexts and how it is measured. Nurs Open 2021; 9:1943-1966. [PMID: 34033697 PMCID: PMC9190696 DOI: 10.1002/nop2.945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Aim To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments. Design Scoping review. Methods Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram. Results Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA‐NH), modified MISSCARE survey and study‐specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.
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Affiliation(s)
- Ingrid Andersson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anna Josse Eklund
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
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Mangrum R, Stewart MD, Gifford DR, Harris Y, Ogletree AM, Bergofsky L, Perfetto D. Omissions of Care in Nursing Homes: A Uniform Definition for Research and Quality Improvement. J Am Med Dir Assoc 2020; 21:1587-1591.e2. [PMID: 32994119 DOI: 10.1016/j.jamda.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022]
Abstract
Omission of care in US nursing homes can lead to increased risk for harm or adverse outcomes, decreased quality of life for residents, and increased healthcare expenditures. However, scholars and policymakers in long-term care have taken varying approaches to defining omissions of care, which makes efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders participated in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition that is clear, meaningful, and actionable for nursing homes. The resulting definition is "Omissions of care in nursing homes encompass situations when care-either clinical or nonclinical-is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident." This concise definition is grounded in goal-concordant, resident-centered care, and can be used for a variety quality improvement purposes and for research.
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Affiliation(s)
- Rikki Mangrum
- American Institutes for Research, Washington, DC, USA.
| | | | - David R Gifford
- American Health Care Association, Washington, DC, USA; Brown University, Providence, RI, USA
| | - Yael Harris
- American Institutes for Research, Washington, DC, USA
| | | | - Linda Bergofsky
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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